Eating Disorders & Substance Use Disorders Commonly Overlap

By Timberline Knolls 

Struggling with an eating disorder or substance use disorder by itself is difficult enough. Facing both of these challenges at the same time can feel impossible.

Unfortunately, these two disorders commonly co-occur. Different studies cite various numbers depending on what is being measured or which population is being studied, but the rate of co-occurrence is generally thought to be somewhere between 17% and 46%.

The likelihood of someone who is living with an eating disorder also misusing substances is particularly high. A 2003 study by the National Center on Addiction and Substance Abuse found that up to 50% of individuals who have an eating disorder abuse alcohol or illicit drugs, compared with just 9% of the general population. That same review found that more than 35% of people who abused substances also had an eating disorder.

Most research seems to note a stronger association between bulimia nervosa and substance use (36.8%), with anorexia (27.0%) and binge-eating disorder (23.3%) the next closest comorbidities.

Complex Illnesses with Complex Relationships 

It’s unclear exactly what the associations between eating disorders and addiction are. Substance use can begin before, at the same time as, or after the onset of an eating disorder, and it’s uncertain whether one drives the other or if they co-occur coincidentally.

People often use food and substances to cope with various obstacles throughout life, so even without a specific link, it’s easy to see how a person in recovery from an eating disorder may use substances to offset the stress of recovery. In a similar manner, a person who is recovering from a substance use disorder may develop disordered eating traits to compensate for the lack of chemical reinforcement in their body.

Based on a variety of research, there are several theories about why these two disorders may overlap. Substance use disorders and bulimia nervosa, for example, seem to share some behavioral traits, such as increased impulsivity. Some researchers believe that both disorders have some common risk factors, such as:

• Low self-esteem, depression, or anxiety
• History of childhood abuse
• Family history of eating disorders or addiction
• History of trauma
• Shared brain chemistry
• Being prone to messages from advertisers or media

How Someone Who Is Struggling Can Get Help

Both eating disorders and substance use disorders can have an array of frightening physical, emotional, and mental complications. Medication that is used to treat certain substance use disorders may exacerbate symptoms of an eating disorder, for instance.

It’s crucial to find a comprehensive treatment model that treats the whole person rather than just the symptoms of addiction or an eating disorder. This method considers each person’s unique needs, caring for both disorders while accounting for the potential of overlapping complications.

Through a holistic approach that may include principles of expressive therapies, family systems, 12 Step, spirituality, nutrition therapy and dialectical behavior therapy (DBT), people who are struggling with co-occurring addictions and eating disorders can begin to find that recovery is attainable.